Every mile you walk puts 60 tons of stress on each foot. Your feet can handle a heavy
load, but too much stress pushes them over their limits. When you pound your feet
on hard surfaces playing sports or wear shoes that irritate sensitive tissues, you
may develop heel pain, the most common problem affecting the foot and ankle. A sore
heel will usually get better on its own without surgery if you give it enough rest.
However, many people try to ignore the early signs of heel pain and keep on doing
the activities that caused it. When you continue to use a sore heel, it will only
get worse and could become a chronic condition leading to more problems. Surgery is
rarely necessary.

Diagnosis

Heel pain can have many causes. If your heel hurts, see your doctor right away to
determine why and get treatment. Tell him or her exactly where you have pain and how
long you've had it. Your doctor will examine your heel, looking and feeling for signs
of tenderness and swelling. You may be asked to walk, stand on one foot or do other
physical tests that help your doctor pinpoint the cause of your sore heel.

Conditions that cause heel pain generally fall into two main categories: pain beneath
the heel and pain behind the heel.

Pain Beneath the Heel

If it hurts under your heel, you may have one or more conditions that inflame the
tissues on the bottom of your foot:

Stone bruise. When you step on a hard object such as a rock or stone, you can bruise the fat pad
on the underside of your heel. It may or may not look discolored. The pain goes away
gradually with rest.

Plantar fasciitis (subcalcaneal pain). Doing too much running or jumping can inflame the tissue band (fascia) connecting
the heel bone to the base of the toes. The pain is centered under your heel and may
be mild at first but flares up when you take your first steps after resting overnight.
You may need to do special exercises, take medication to reduce swelling and wear
a heel pad in your shoe.

Heel spur.When plantar fasciitis continues for a long time, a heel spur (calcium deposit) may
form where the fascia tissue band connects to your heel bone. Your doctor may take
an X-ray to see the bony protrusion, which can vary in size. Treatment is usually
the same as for plantar fasciitis: rest until the pain subsides, do special stretching
exercises and wear heel pad shoe inserts.

Pain Behind the Heel

If you have pain behind your heel, you may have inflamed the area where the Achilles
tendon inserts into the heel bone (retrocalcaneal bursitis). People often get this
by running too much or wearing shoes that rub or cut into the back of the heel. Pain
behind the heel may build slowly over time, causing the skin to thicken, get red and
swell. You might develop a bump on the back of your heel that feels tender and warm
to the touch. The pain flares up when you first start an activity after resting. It
often hurts too much to wear normal shoes. You may need an X-ray to see if you also
have a bone spur.

Treatment includes resting from the activities that caused the problem, doing certain
stretching exercises, using pain medication and wearing open back shoes.

Your doctor may want you to use a 3/8" or 1/2" heel insert.

Stretch your Achilles tendon by leaning forward against a wall with your foot flat
on the floor and heel elevated with the insert.

AAOS does not endorse any treatments, procedures, products, or physicians referenced
herein. This information is provided as an educational service and is not intended
to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance
should consult his or her orthopaedic surgeon, or locate one in your area through
the AAOS "Find an Orthopaedist" program on this website.